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Review the hospital and claim information provided. Calculate the cost, MS-DRG payment, fixed-loss cost threshold, outlier add-on amount, total payment, and profit/loss amount for
Review the hospital and claim information provided. Calculate the cost, MS-DRG payment, fixed-loss cost threshold, outlier add-on amount, total payment, and profit/loss amount for each claim for each provider using Excel formulas. The IPPS high-cost outlier threshold for FY 2020 is $26,473.00 Once you have completed the calculations, answer the corresponding questions. 0 1 21 Hospital Information 3 Hospital CCR Base Rate 4 Hospital A 0.429 $ 6,200.00 5 Hospital B 0.621 $ 6,200.00 6 Hospital C 0.429 $ 8,000.00 7 Hospital D 0.621 $ 8,000.00 8 9 0 Claim MS-DRG Claim Information MS-DRG Description 1 1 469 Major joint replacement or reattachment of lower extremity with MCC 2 2 003 3. 3 193 4. 4 459 ECMO or Tracheostomy with MV 96+ hours or PDX excluding face, moth & neck with major OR procedure Simple pneumonia & pleurisy with MCC Spinal fusion except cervical with MCC 5 6 Hospital A 7 Claim Cost MS-DRG Payment Fixed-loss cost threshold Outlier Amount Total Payment Profit/Loss 8 1 9 2 0 3 1 4 2 TOTAL Profit/loss 3 Hospital B 4 Claim Cost MS-DRG Payment Fixed-loss cost threshold Outlier Amount Total Payment Profit/Loss 5 1 6 2 7 8 0. 3 4 TOTAL Duft/lan RW Total Charges 3.1399 $ 50,995.12 18.9539 $ 323,546.55 1.3335 $ 75,654.25 6.852 $ 201,654.82 T + Claim MS-DRG 1 469 Major joint replacement or reattachment of lower extremity with MCC 2 003 3 193 Claim Information MS-DRG Description ECMO or Tracheostomy with MV 96+ hours or PDX excluding face, moth & neck with major OR procedure Simple pneumonia & pleurisy with MCC 4 459 Spinal fusion except cervical with MCC Hospital A Claim Cost MS-DRG Payment Fixed-loss cost threshold Outlier Amount Total Payment Profit/Loss 1 2 3 4 TOTAL Profit/loss Hospital B Claim Cost MS-DRG Payment Fixed-loss cost threshold Outlier Amount Total Payment Profit/Loss 1 2 3 4 TOTAL Profit/loss Hospital C Claim Cost MS-DRG Payment Fixed-loss cost threshold Outlier Amount Total Payment Profit/Loss 1 2 3 4 TOTAL Profit/loss Hospital D Claim Cost MS-DRG Payment Fixed-loss cost threshold Outlier Amount Total Payment Profit/Loss 1 2 3 4 TOTAL Profit/loss
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